Healthcare Provider Details

I. General information

NPI: 1245286764
Provider Name (Legal Business Name): SHELLY A SEIFERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 KIRKWOOD MALL
BISMARCK ND
58504-5752
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4507
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6000
  • Fax: 701-530-6430
Mailing address:
  • Phone: 701-530-6000
  • Fax: 701-530-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7729
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: